Cone Bean Computed Tomography Research Articles

Quantitative assessment of cleft volume and evaluation of cleft’s impact on adjacent anatomical structures using CBCT imaging

ObjectivesTo determine pre-operative cleft volume and evaluate cleft´s impact on surrounding anatomical structures in children and adolescents with orofacial clefts using cone bean computed tomography (CBCT) imaging.MethodsThe present retrospective study retrieved CBCT examinations of 68 patients from a previous study. The examinations had been exposed either before (n = 53) or after (n = 15) alveolar bone grafting. Pre-operative volume of cleft was determined, and type and location were evaluated. Morphological changes on the adjacent anatomical structures, including the incisive foramen, the nasal septum and floor, and the inferior turbinate, were assessed.ResultsMean bilateral cleft volume was 0.76 cm3, while mean unilateral cleft volume was 1.08 cm3; the difference was significant (p < 0.001). Variation in cleft volume, however, was large. The incisive foramen was not visible in the majority of cases with bilateral clefts (71%); the difference was significant (p = 0.001). In cases with unilateral clefts, the nasal septum in 87% was curved towards the cleft or graft side. Also, the mean size of the widest part of the inferior turbinate was 8.8 mm on the cleft or graft side and 10.4 mm on the non-cleft side. The difference was significant (p < 0.001).ConclusionsWhen required, CBCT is a feasible method for quantitatively illustrating alveolar clefts and their impact on the morphological development of surrounding structures. Variation in cleft volume was large.

Impact of 3D imaging techniques and virtual patients on the accuracy of planning and surgical placement of dental implants: A systematic review.

The integration of advanced technologies, including three-dimensional (3D) imaging modalities and virtual simulations, has significantly influenced contemporary approaches to preoperative planning in implant dentistry. Through a meticulous analysis of relevant studies, this review synthesizes findings related to accuracy outcomes in implant placement facilitated by 3D imaging in virtual patients. A comprehensive literature search was conducted across relevant databases to identify relevant studies published to date. The inclusion criteria were studies utilizing 3D imaging techniques, virtual patients, and those focusing on the accuracy of dental implant planning and surgical placement. The selected studies were critically appraised for their methodological quality. After a rigorous analysis, 21 relevant articles were included out of 3021 articles. This study demonstrates the versatility and applicability of these technologies in both in vitro and in vivo settings. Integrating Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM), cone bean computed tomography (CBCT), and advanced 3D reconstruction methodologies showcases a trend toward enhanced precision in implant planning and placement. Notably, the evaluation parameters varied, encompassing distances, discrepancies, and deviations in the implant placement. The ongoing integration of systems such as dynamic navigation systems, augmented reality, and sophisticated software platforms shows a promising trajectory for the continued refinement of virtual reality applications in dental implantology, providing valuable insights for future research and clinical implementation. Moreover, using stereolithographic surgical guides, virtual planning with CBCT data, and 3D-printed templates consistently demonstrates enhanced precision in dental implant placement compared to traditional methods. The synthesis of the available evidence underscores the substantial positive impact of 3D imaging techniques and virtual patients on dental implant planning and surgical placement accuracy. Utilizing these technologies contributes to a more personalized and precise approach that enhances overall treatment outcomes. Future research directions and potential refinements to the application of these technologies in clinical practice should be discussed.

Recommendations for standard criteria for the positional and morphological evaluation of temporomandibular joint osseous structures using cone-beam CT: a systematic review.

This systematic review aimed to appraise the reliability and comprehensiveness of imaging methods in studies that used three-dimensional assessment of the temporomandibular joint (TMJ) in order to propose a standardized imaging method. Six databases/search engines were searched up until September 2022. The outcomes of interest included measurements of the mandibular condyle, glenoid fossa, joint spaces, or the entire TMJ. Two checklists were utilized: one to assess the risk of bias, with a maximum score of 37, and the other, a pre-designed checklist consisting of 22 items to evaluate the comprehensiveness of the methods used, with a maximum score of 33. Out of the 2567 records retrieved, only 14 studies, which used cone bean computed tomography (CBCT), were deemed eligible and thus included in the qualitative analysis. Three studies were deemed of low risk of bias, while the remaining studies were rated as moderate to high risk of bias, primarily due to improper reporting of inter-observer agreement, varying reliability values, and a limited number of cases included in the reliability analysis. Regarding the comprehensiveness of the methods used, only four studies achieved relatively high scores. The deficiencies observed were related to the reporting of variables such as slice thickness and voxel size, absence of or improper reporting of intra- and inter-examiner reliability analyses, and failure to assess all osseous components of the TMJ. CBCT-based methods used to assess the positions and morphology of TMJ bony structures appear to be imperfect and lacking in comprehensiveness. Hence, criteria for a standardized assessment method of these TMJ structures are proposed. Accurately, comprehensively, and reliably assessing the osseous structures of the temporomandibular joint will provide valid and valuable diagnostic features of the normal temporomandibular joint, and help establish potential associations between these osseous features and temporomandibular disorders. The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199792). •Although many methods have been introduced to assess the osseous structure of the temporomandibular joint, they yielded inconsistent findings. •None of the published studies comprehensively assessed the temporomandibular joint. •Recommendations for a comprehensive temporomandibular joint osseous assessment method were suggested for better validity and reliability of future research.

Comparative Evaluation of Efficacy of Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) in Bone Regeneration after Surgical Removal of Impacted Bilateral Mandibular Third Molars - A Comparative Study.

Aims and Objectives: To compare the efficacy of platelet rich plasma (PRP) and platelet rich fibrin (PRF) in bone regeneration after removal of impacted bilateral third molars. Materials and Methods: The study was carried out as an open clinical trial on 20 patients chosen from the ones referred to the department of Oral & Maxillofacial Surgery for surgical removal of bilateral mandibular third molar. Patients were prepared for surgical procedure, Inferior alveolar nerve block given using 2% lignocaine hydrochloride with 1:2,00,000 adrenaline. Third molar were removed by flap reflection and bone drilling. Finally, PRF in lower left mandibular third molar region and PRP in lower right mandibular third molar region was inserted and wound closure was done. Cone bean computer tomography (CBCT) was made on 1st postoperative day and 4 months after surgery to evaluate alveolar bone height and density. Result: Alveolar bone height and bone density at post-operative 1st day and 4 months were compared between PRP and PRF group. The bone density and bone volume were analyzed, and there was no significant difference between bone density in PRP and PRF at day 1 and 4th month. Conclusion: As per our study and evaluation, in our postoperative follow up there was no statistically significant differences in bone regeneration by placement of PRP and PRF in extracted socket of third molar. Thus, with this study we can conclude that PRF, would be a good option to Oral and Maxillofacial Surgeons in the near future due to ease of extraction.

Clinico-Radiographic Research Evaluating Crestal Bone Level and Bone Density Surrounding Dental Implants.

Planning the surgical operation, choosing the type of implant, and the effectiveness of the implant all heavily rely on the quantity and quality of the accessible bone. This study's goal was to determine how promptly inserted dental implants affected postoperative changes in bone density and crestal bone level by Cone bean computed tomography (CBCT) gray-scale value during a follow-up of three to six months. A prospective clinical-radiographic investigation was conducted. Twenty participants with a partly edentulous arch who were also systemically healthy were chosen from the OPD of the Department of Periodontics and Oral Implantology. Each patient's oral hygiene status was noted, and a preoperative CBCT was performed to assess bone density. The following clinical parameters were noted before surgical procedures: plaque index (PI) (Silness and Loe, 1964), gingival index (GI) (Loe and Sillness, 1964), probing pocket depth (PPD), and primary stability. A weak connection between Hounsfield unit (HU) in three months and six months was found. Moreover, a slender positive connection between baseline primary stability and three months was found. PI was shown to have a statistically significant difference between the means at several follow-ups (P value of 0.0001). PI and probing depth were not statistically different between baseline and six months (P values = 0.0001) or between three months and six months (P values = 0.050), respectively. The main outcome of this study shows that insertion torque is directly proportional to bone density and crestal bone level.

Association of prosthetic angles of the Implant Supracrestal Complex with peri-implant tissue mucositis.

The aim of this study was to investigate the association of the Mucosal Emergence Angle (MEA) with peri-implant tissue mucositis. Forty-seven patients with 103 posterior bone level implants underwent clinical and radiographic examination. Three-dimensional data from Cone Bean Computer Tomography and Optica Scan were transposed. Three angles were defined: MEA, Deep Angle (DA) and Total Angle (TA) and measured at six sites for each implant. There was a significant correlation between MEA and Bleeding on Probingfor all sites with an overall odds ratio of odd ratio1.07 (95% confidence interval [CI] 1.05-1.09, p < 0.001). Sites with MEA ≥ 30°, 40°, 50°, 60°, and 70° had a higher risk for bleeding with an odds ratio of 3.1, 5, 7.5, 11.4 and 33.55, respectively. When all 6 sites of an implant prostheses had MEA ≥ 40°, the risk of having bleeding at all 6 sites was 9.5 times higher (95%CI 1.70-52.97, p = 0.010). Maintaining MEA no wider than 30°-40° is advisable, while the aim should be to keep this angle as narrow as clinically feasible.Registered in Thai Clinical Trials Registry: http://www.thaiclinicaltrials.org/show/TCTR20220204002.

The Impact of Technological Innovation on Dentistry.

Technology has revolutionized the way dentists are able to treat their patients. These technological advances have paved the way for the creation of virtual patient models utilizing these 3-dimensional intra-oral patient models, cone bean computer tomography (CBCT) radiograph scans, extraoral 3-dimensional scans, and jaw motion tracings to create a patient-specific model. These models are advantageous in planning surgical treatments by providing 3-dimensional views of vital anatomical structures to accurately identify the location, size, and shape of a structure or defect in order to plan accordingly. Virtual augmentation of either hard tissue (bone) and/or soft tissue (i.e., gingiva) can also be accomplished.Technology has allowed the capture of the dynamic motions of the jaw and combined them with the virtual patient to develop permanent restorations in harmony with the patient's orofacial complex. With the introduction of new technology in the realm of digital dentistry, patient care is being brought to a new and higher level. This creates a level of more optimal care that a dentist can deliver to patients.

Is Intraoral Scanning Accurate to Evaluate Dental Implant Position? An In-Vitro Study

The position of dental implants is generally verified through imaging exams, even though its use exposes patients to radiation. Intraoral scanning (IOS) may be a suitable alternative to using radiographic imaging to verify implant position. Using polyurethane jaw models, the purpose of this in-vitro study was to measure and compare implant positions determined by IOS and cone-bean computed tomography (CBCT). One hundred twenty implants were installed in 30 edentulous polyurethane jaws, 4 dental implants in each prototype. Four scanbodies were attached to the implants, and a scanning of each mandible was acquired using an intraoral scanner (CS 3600). All prototypes were also submitted to CBCT. Then, the 3D scan files in STL (Standard Tessellation Language) format were superimposed on the DICOM (Digital Imaging and Communications in Medicine) images of the tomographic mandibles. The accuracy of IOS was evaluated by the metric analyses of deviations between the position of the implants projected by the IOS versus the detected tomographically, in which CBCT served as the gold standard, using a free software for digital planning (Bluesky 4 - Grayslake, IL, USA). The following measures were analyzed: radial deviations at the shoulder (Xc) and at the apex of the implants (Xa), height deviation (Xh) and axial deviation. Bland-Altman and a paired t-test were applied to verify the reproducibility between measurements and a t-test for a mean was applied to compare the measurements with zero value. The results showed Xc and Xa deviation means of 0.14±0.09mm and 0.12±0.12mm, respectively. The Xh mean was 0.2±0.12mm and the axial deviation mean was 0.71°±0.66°. T-test showed a statistically significant difference when the 4 means were compared to zero value, represented by the CBCT (P<.0001). There was a statistically significant difference IN the scanned measures compared to CBCT as the standard, but the differences may not be clinically significant. The IOS utilization to evaluate the position of dental implants is a radiation-free and reproducible method, with the advantage of not generating metal artifacts. Further clinical studies are needed to validate this new method of postoperative evaluation.

Age Estimation Using Maxillary Central Incisor Analysis on Cone Beam Computed Tomography Human Images.

Forensic dentistry plays an important role in human identification, and dental age estimation is an important part of the process. Secondary dentin deposition throughout an individual’s lifetime and consequent modification in teeth anatomy is an important parameter for age estimation procedures. The aim of the present study was to develop regression equations to determine age in adults by means of linear measurements and ratios on sagittal, coronal and axial slices of maxillary central incisors using cone bean computed tomography (CBCT). Multiplanar measurements of upper central incisors were taken for a sample of 373 CBCTs. Subsequently, one-way analysis of variance (ANOVA) and multivariate linear regressions were performed for age estimation. The equations obtained from axial linear measurements and ratios presented a standard error of the estimate (SEE) of ±10.9 years (R2 = 0.49), and a SEE of ±10.8 years (R2 = 0.50), respectively. The equation obtained for multiplanar linear measurements presented a SEE of ±10.9 years (R2 = 0.52), while the equation for multiplanar ratios presented a SEE of ±10.7 years (R2 = 0.51). Thus, CBCT measurements on upper central incisors were found to be an acceptable method for age estimation. Horizontal measurements, especially pulp measurements, improve the accuracy of age estimate equations.

Crown-root angulations of the maxillary anterior teeth according to malocclusions: A cone-beam computed tomography study in Korean population.

To compare crown-root angulations of the permanent maxillary anterior teeth in skeletal Class I, Class II, and Class III Korean malocclusion patients using cone-bean computed tomography (CBCT) images. Sixty CBCT images were collected from orthodontic patients archive based on skeletal Class I (0˚< A point-nasion-B point angle [ANB] < 4˚), Class II (ANB ≥ 4˚), and Class III (ANB ≤ 0˚) to have 20 samples in each group. Mesiodistal crown-root angulation (MDCRA) and labiolingual crown-root angulation (LLCRA) were evaluated after orientation of images. Crown-root angulations were compared among Class I, Class II, and Class III groups and among the maxillary anterior teeth in each group. LLCRAs of the maxillary central incisor and the lateral incisor were significantly lower in Class III group than those in Class I group. However, those of the canine showed no significant differences among groups. MDCRAs of the maxillary anterior teeth did not significantly differ among groups either. Our results suggest that skeletal Class III malocclusion might affect LLCRA of the maxillary incisors, especially the central incisor.

IMPORTANCE OF CBCT FOR DIAGNOSIS OF DENTAL FRACTURE IN A POST-TRAUMA PATIENT: CASE REPORT

Digital periapical radiographs are one of the exams of choice that enable the identification of dental fracture lines in some cases. However, because of it bidimensional nature, the overlap of other structures can occur, interfering in the final diagnosis. On the other hand, cone bean computed tomography (CBCT) and other dental software are important because they transform 2D images into 3D images, without deformation and overlaps, with precise measures and new visualization plans, which make correct diagnosis easier. A 53-year-old woman reported unspecific pain in maxillary anterior region. Clinical and periapical radiography exams did not show any problems. CBCT showed a line of coronary fracture in tooth 11. CBCT is very important for the development of a correct diagnosis of unspecific pain in teeth that suffered from trauma and were not diagnosed by conventional radiographic exams. Digital periapical radiographs are one of the exams of choice that enable the identification of dental fracture lines in some cases. However, because of it bidimensional nature, the overlap of other structures can occur, interfering in the final diagnosis. On the other hand, cone bean computed tomography (CBCT) and other dental software are important because they transform 2D images into 3D images, without deformation and overlaps, with precise measures and new visualization plans, which make correct diagnosis easier. A 53-year-old woman reported unspecific pain in maxillary anterior region. Clinical and periapical radiography exams did not show any problems. CBCT showed a line of coronary fracture in tooth 11. CBCT is very important for the development of a correct diagnosis of unspecific pain in teeth that suffered from trauma and were not diagnosed by conventional radiographic exams.

Accidental nasal fossa perforation during endodontic treatment - Case report

Fracture of an endodontic instrument within the root canal system can occur due to incorrect use of instruments, and clinicians are confronted with a few removal options when considering this situation. The purpose of this article is to present the removal of a fractured endodontic file from the periapical region of the right upper central incisor, that caused a nasal floor perforation and otorhinolaryngological symptoms, with the aid of a dental operating microscope (DOM) and cone bean computed tomography (CBCT). Success was achieved when the fragment was visible and removed from the nasal fossa. The standardized techniques of removal or bypassing fracture file were not effective, and success was obtained with the aid of CBCT that made possible the visualization of the broken file inside the nasal fossa.

Spontaneous healing response of oblique root fracture: case report with 4-year follow-up

Root fractures can involve the dentin, cementum, and pulp and commonly can occur as oblique fractures with varying orientations. The aim of this study was to demonstrate the maintenance of pulp health in a tooth with a fractured root without any endodontic treatment and to discuss the advantage of cone-bean computed tomography (CBCT) compared with traditional radiographs in the diagnosis of oblique root fractures. Intra-oral radiography of tooth 11 revealed a horizontal root fracture at the level of the apical third, while the sagittal CBCT slice reveals a complete fracture line running obliquely from the apical third on the buccal aspect through the cervical third on the palatal aspect.  Four years follow-up, the tooth has kept its pulp vitality, no tooth discoloration or discrepancy in arch position, without endodontic treatment. This result illustrates spontaneous healing of root fracture including preservation of pulp health. In addition, it confirms the importance of exams in 3 dimensions to correctly locate the fracture and assist in the treatment decision.

The Maxillary Artery Definition According to CBCT Data in Patients with Chronic Maxillary Sinusitis

The number of maxillary sinusitis is significant in the structure of inflammatory diseases in an outpatient maxilla-facial surgery and they are one of the chief reasons for the patients’ hospitalization. The anatomy of maxillary sinus with 3D Computer tomography scan should be included in appropriate presurgical treatment planning. The purpose of the study was to determine the visualization and diameter of the maxillary artery in according analyzing of Cone bean computer tomography data of patients, to identify the relationship between the presence of chronic maxillary sinusitis and the visualization of the maxillary artery and its diameter. Material and methods. The data of 44 Cone bean computer tomography results was analyzed for 24 patients with chronic maxillary sinusitis of odontogenic origin (it was observation group 1, included 48 sinuses), 20 patients were without pathological changes in the maxillary sinus (it was comparison group 2, included 40 sinuses). All the Cone bean computer tomographies randomly selected by patients who visited dental outpatient clinics of Minsk city, the Republic of Belarus during the period from 2018 to 2020 and were analyzed by GALILEOS program. Results and discussion. The analysis revealed that maxillary artery was not detected in 25.0% (12) patients of group 1, while in group 2 it was not detected in 5.0% (2) patients. When determining the diameter of the maxillary artery, we found that in group 1 patients, the artery diameter 0.1-0.99 mm was determined in 91.7% (33) cases, and in 92.2% (35) of group 2 patients; the diameter of the maxillary artery 1.0 mm or more in group 1 patients was determined in 8.3% (3) of observations, and in 7.8% (3) of group 2 patients Different types of the maxillary arteries localization were revealed. Conclusion. The study results showed that in patients of group 1 with the presence of chronic maxillary sinusitis, the maxillary artery was not visualized 5 times more often than in patients of group 2 (comparison group), which may indicate to deeper ischemic changes in the maxillary tissues of patients with chronic maxillary sinusitis. There was no significant difference in the diameter of the maxillary arteries in groups 1 and 2. The study will be continued

Influence of orthodontic treatment with premolar extraction on the spatial position of maxillary third molars in adult patients: a retrospective cohort cone-bean computed tomography study

BackgroundBased on low-dose radiation Cone-bean computed tomography (CBCT) images, This study aims to establish a space coordinate system, which offers more precise and comparable evaluation on changes of maxillary third molars influenced by orthodontic treatment with premolar extraction in adults. The system suggests promising application prospect in future studies related to CBCT superimposition and evaluation for its feasibility and efficiency.MethodsForty-nine maxillary third molars from 27 patients (mean age, 20.78 years) were included. CBCT images were obtained before and after orthodontic treatment with premolars extracted (mean treatment duration, 31.47 months). The changes in the position, angulation, and rotation of the third molars were evaluated with a space coordinate system using four landmarks: anterior nasal spine (ANS), posterior nasal spine (PNS), left and right orbitales.ResultsAfter orthodontic treatment, the third molars moved forward (adjusted mean, 1.44 mm) (p < 0.001) and downward (adjusted mean, 2.87 mm) (p < 0.001) accompanied by outward rotation of the crowns (adjusted mean, 5.38°) (p = 0.001), while changes in angulation were insignificant.ConclusionsThis was the first study to systematically investigate the spatial position change of maxillary third molars in adult patients who received orthodontic treatment with premolar extraction. During the process, maxillary third molars moved downward and forward accompanied by outward rotation of the crowns. Orthodontists should take tooth movement potential into consideration when making extraction plans.

Late removal of an upper third molar displaced into the infratemporal space using an intermaxillary fixation screw: a case report

Teeth displacement during extractions even tough rare are extremely unwanted, especially for infra temporal space. This accident generally necessitate additional treatment for their resolution, being either immediate or late. Several authors discribed surgical techniques for removal displaced teeth into the infratemporal space, varying according to the degree of displacement, being that in some of this cases, is necessary the utilization of complementary tools. This case describes the technique utilized for late removal of tooth 18 (upper right third molar) dislocated into the lower portion of the infratemporal space (confirmed by the Cone Bean Computer tomography Scan), exam was performed after the patient reported pain in the operated region and during mandibular movement too, with an interincisal opening maximum of 20 millimeters. The procedure was realized under local anesthesia by a conservative intraoral approach and aid of intermaxillary fixation screw to facilitate extraction. The patient recovered well, without complications, with remission of pain and restoration of mouth opening.

Evaluation of total bone and cortical bone thickness of the palate for temporary anchorage device insertion

Background/purposeThe palate has become a popular site for the placement of temporary anchorage devices (TADs) owing to its bone quantity and quality. This study aimed to investigate total and cortical bone thicknesses in the whole palate as well as palatal width using a standard grid system and cone-bean computed tomography (CBCT) images. Materials and methodsThe CBCT images of 43 samples were selected. The total bone and cortical bone thicknesses of the palate were surveyed on 64 points per patient. The palatal width was measured. The difference between the age and sex groups was analyzed. ResultsThe total palatal bone thickness in the adult group ranged from 9.85 ± 2.04 to 1.87 ± 0.79 mm. In the adolescent group, we found one-third of the incisor roots in the area 3 mm distal to the incisive foramen and 8 mm lateral to the mid-palatal suture. The cortical bone thickness in adults was significantly thicker in the posterior paramedian area than that in adolescents. ConclusionThe thickest vertical bone is located in the zone 3 mm distal to the incisive foramen and 4–8 mm lateral to the midpalate. The zone 6 mm posterior to the incisive foramen and 2–8 mm lateral to the midpalate exhibited optimal thickness and was away from the incisor roots. This region could be a safe zone for adolescent patients to place TADs. When TADs are to be inserted at the posterior palate, the 2-mm paramedian area should be the first region of choice.

EVALUATION OF SHAPING EFFICACY AND CANAL CENTERING ABILITY OF RECIPROCATING HANDPIECE WITH STAINLESS STEEL K FILE, NITI K FILE AND WAVEONE USING CBCT.

Introduction: Continuously tapered form of root canal and to maintain the original shape and position of the apical foramen is the key element in root canal treatment. However, canal curvature may cause difficulty in instrumentation. Aim: The aim of this study was to evaluate the shaping efficacy and centering ability of reciprocating handpiece with stainless steel (SS) K files and Nickel Titanium (NiTi) K files in 90 degree and WaveOne gold file system in 150 counterclockwise and 30 clockwise reciprocation using cone bean computer tomography.&#x0D; Materials and methods: Thirty freshly extracted human mandibular molars with fully formed apices were taken for the study and 11 mm of distal roots were used for the study. They were divided into three groups (n=10). All the three groups were instrumented using reciprocating handpiece. The file system used for Group 1, 2 and 3 are SS k file, NiTi K files, and WaveOne gold file respectively.&#x0D; Statistical analysis: Data was tabulated and One-way analysis of variance (ANOVA) followed by Tukey post hoc honestly significant difference (HSD) test were conducted at p=0.05 significance.&#x0D; Results: The results revealed significant variations in shaping efficacy and centering ability at various level by all the three file system. A good canal taper and improved shaping efficacy was significantly reported in favor of WaveOne gold reciprocating file.&#x0D; Conclusion: The WaveOne Gold showed better shaping ability whereas the canal centering ability at the coronal, middle and the apical third were not found uniform for the three tested instrument.&#x0D; Keywords: Shaping efficacy, Canal centering, reciprocating handpiece, NiTi files, WaveOne Gold, CBCT

Prevalence and morphology of multiple roots, root canals and C-shaped canals in mandibular premolars from cone-beam computed tomography images in a Thai population

Background/purposeVariations in root and root canal morphology of mandibular premolars of Thais has not been reported, and understanding these variations enhances endodontic success. The purpose was to investigate prevalence and morphology of multiple roots, root canals and C-shaped canals in mandibular premolars in a Thai population from cone-bean computed tomography (CBCT) images. Materials and methodsA total of 349 first mandibular premolars and 416 second premolars from CBCT images with 0.125-mm voxel size and 60 × 60 mm field of view were evaluated. Number of roots, root canals, and C-shaped canals were recorded and statistically analyzed using chi-square test. Root canal configurations were defined according to the Vertucci's classification. Levels and distances of separated multiple canals were reported. ResultsMultiple roots in mandibular first premolars were found at 5.73% while none of second premolars had. Multiple root canals were found in the first premolars at 19.48% and the second premolars at 3.85%. C-shaped canals (C1/C2) were found in the first premolars at 3.72% and the second premolars at 0.48%. All parameters in the first premolars were significantly higher than in the second premolars (p < 0.01). The majority of multiple root canals were defined as Vertucci's type V (1–2 canals). Multiple root canals were frequently separated at the middle level of roots about 6.5–7.0 mm from the cementoenamel junction. ConclusionPrevalence of multiple roots/root canals and C-shaped canals in mandibular first premolars were significantly higher than in mandibular second premolars. Level of separation in multiple root canals was frequently at the mid-root level.

Evaluation of the Lingual Canals of Mandible in Cone Beam Computed Tomography

This study aims to assess the frequency of the lingual foramina and canals relative to their location on the mandibular cortical plate and also to closely inspect the course of the lingual canals inside the mandibular body using 3D reconstruction of the evaluated area. A retrospective study was conducted with 55 cone bean computed tomography (CBCT) scans in order to analyze the location, number, course and anastomosing pattern of the lingual canals. A total number of 165 lingual canals (LCs) were recorded from 55 patients, as follows: 94 median (MLC), 16 paramedian (PLC) and 55 lateral lingual canals (LLC). MLCs were a constant finding in all 55 patients (100% of the cases), PLCs were present in 15 patients (27.3% of the cases), and LLCs were identified in 35 patients (63.3% of the cases). The anastomosing pattern of the MLC, in which a supraspinous canal anastomosed with an infraspinous canal, was found in 10.9% of the cases (6 of 55 patients),. The LLCs were anastomosed with the mandibular incisive canal (MIC) in 56.3% of the cases (31 of 55 LLCs) and with the mandibular canal (MC) in 3.6% of the cases (2 of 55 LLCs). CBCT revealed itself to be a reliable tool for evaluating the intramandibular topography of the LCs. The anastomosing pattern of the lingual canals might raise the question whether the LCs could be responsible for incomplete anesthesia after conventional mandibular block by carrying sensory innervation from the mylohyoid nerve to the inferior alveolar nerve.